Awake intubation: Difference between revisions
Ldperkins23 (talk | contribs) (Awake Intubation is a safe and effective alternative to a select subset of patients who would be otherwise difficult ventilate/intubate) |
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<ref> Awake Intubation | British Journal of Anaesthesia </ref> | <ref> Awake Intubation | British Journal of Anaesthesia </ref> | ||
https://academic.oup.com/bjaed/article/15/2/64/248570 | |||
==References== | |||
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[[Category:Critical Care]] | |||
[[Category:Procedures]] | |||
Revision as of 04:19, 20 February 2018
Awake Intubation
May use any of the following techniques:
- Fiberoptics (most common)
- Direct Laryngoscopy
- Video Laryngoscopy
- Blind Nasal Intubation
- Tracheostomy
Indications
When masked ventilation or intubation is suspected to be difficult, such as those with complicated anatomy or cannot tolerate supine positioning
Contraindications
Patient compliance or refusal
Drugs
It is important to maintain spontaneous breathing
- Local anesthetics (i.e. lidocaine)
- Sedation - must be mild to avoid respiratory depression or apnea. Sedation is frequently required for patient tolerance
- Midazolam - used in small boluses, but has no analgesic properties (may use fentanyl in addition)
- Propofol - challenging to balance sedation
- Dexmedetomidine
- Remifentanil - rapid offset of action
Example of Technique
- Preoxygenate the patient
- Position the patient
- Switch oxygenation from face mask to nasal cannula
- Topical anesthesia
- May be done via transtracheal route, allowing for possible Seldinger cricothyroidotomy, if necessary as a back-up.
- Light Sedation
- Visualization of anatomy
- Intubate
- Confirm Placement
- Secure Endotracheal Tube
- Sedation/analgesia for patient
[1] https://academic.oup.com/bjaed/article/15/2/64/248570
References
- ↑ Awake Intubation | British Journal of Anaesthesia